Ha Andrew C T, Mazer Cyril David, Verma Subodh, Yanagawa Bobby, Verma Atul
aPeter Munk Cardiac Centre, University Health Network bDepartment of Medicine, University of Toronto cDepartment of Anesthesia, University of Toronto dLi Ka Shing Knowledge Institute, St Michael's Hospital eDepartment of Surgery, University of Toronto fDivision of Cardiac Surgery, St Michael's Hospital, Toronto gDivision of Cardiology, Southlake Regional Health Centre, Newmarket, Canada.
Curr Opin Cardiol. 2016 Mar;31(2):183-90. doi: 10.1097/HCO.0000000000000264.
Postoperative atrial fibrillation (POAF) occurs commonly after cardiac surgery and is associated with a number of adverse outcomes. This article will review the available evidence on the prevention and treatment of atrial fibrillation after cardiac surgery. Using this knowledge, we propose a conceptual framework on the management of patients with POAF during various phases after cardiac surgery.
Perioperative β-blockade is the cornerstone in preventing POAF after cardiac surgery. Results from randomized trials do not support routine use of colchicine or corticosteroids to prevent POAF. There is no study examining the impact of rate versus rhythm control on 'hard' clinical outcomes such as mortality or stroke in the cardiac surgical population. Furthermore, there is a paucity of research on the optimal timing and choice of oral anticoagulation among POAF cardiac surgical patients who are at risk for stroke.
In spite of the plethora of therapies available to treat and prevent POAF in the cardiac surgical population, there is little data to address whether they can improve key clinical outcomes such as death or stroke. Guideline recommendations on rate/rhythm control and oral anticoagulation for stroke prevention in the cardiac surgical population are largely extrapolated from studies of nonsurgical atrial fibrillation patients. Further research is needed to address these key atrial fibrillation management issues specific to the cardiac surgical population.
术后房颤（POAF）在心脏手术后很常见，且与许多不良后果相关。本文将综述心脏手术后房颤预防和治疗的现有证据。基于这些知识，我们提出了一个关于心脏手术后不同阶段POAF患者管理的概念框架。
围手术期β受体阻滞剂是预防心脏手术后POAF的基石。随机试验结果不支持常规使用秋水仙碱或皮质类固醇预防POAF。尚无研究探讨心率控制与节律控制对心脏手术人群死亡率或中风等“硬”临床结局的影响。此外，对于有中风风险的POAF心脏手术患者，关于口服抗凝的最佳时机和选择的研究很少。
尽管有大量治疗方法可用于治疗和预防心脏手术人群中的POAF，但几乎没有数据表明这些方法能否改善死亡或中风等关键临床结局。心脏手术人群中关于心率/节律控制和预防中风的口服抗凝的指南建议很大程度上是从非手术房颤患者的研究中推断出来的。需要进一步研究来解决这些心脏手术人群特有的关键房颤管理问题。
